TDF domain (and definition) (26)
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Survey identified Barriers
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Survey
identified
Enablers
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BCW Intervention components (25)
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Definition of intervention with examples of Behaviour Change Techniques (27)
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Strategy operationalised as:
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Knowledge -
An awareness of the existence of something
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Unsure of clinical areas BCA would benefit
75% (n=12) unsure who to use on;
69% (n=11) unsure when to do;
69% (n=11) unsure what to do;
62.5% (n=10) unsure how to interpret;
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Psychological capability
Education
Training
Enablement
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Increasing knowledge or understanding:
E.g.
Feedback on the behaviour/ outcome(s) of the behaviour
Self-monitoring of behaviour/ of outcome of behaviour
Prompts/cue
Information about social and environmental consequences
Information about others’ approval
Imparting skills
Reducing barriers to increase capability or opportunity (beyond education, training and environmental restructuring)
E.g.
Social support
Reduce negative emotions
Conserve mental resources
Self-monitoring of behaviour and outcome of behaviour
Graded tasks
Adding objects to the environment
Restructuring the social environment
Focus on past success
Verbal persuasion about capability
Self-reward
Goal setting (behaviour, outcome)
Commitment
Action planning
Review behaviour and outcome goal(s)
Discrepancy between current behaviour and goal
Problem solving
Pros and cons
Monitoring of emotional consequences
Anticipated regret
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· PD sessions(KPI: ≥ 3/y, ≥ 15 attendees) (Topics: Body Composition Assessment - overview; Practical on how to assess and interpret BCA; Case Study – diagnosis and follow up; Implementation plan; Sarcopenia)
· Workshops to practice all BCA procedures (KPI:≥ 2/y, ≥ 2 attendees)
· BPI and WAR updating exercise by dietitians: literature review and integrating evidence and procedures into BPIs and WARs
Information sharing from WARs and BPIs amongst teams in the department
· Clinical champions – 6 month graded WAR adoption project using accountability, peer modelling and influence.
· Set goals on increasing numbers of BCAs in eligible patients in each area
Feedback in department meeting after 3 months, new goal setting
· Use social support: peer support within streams, clinical champions assisting and upskilling peers, reporting in streams and department meetings, BC team members meeting with individual staff members and helping to get body comp Ax running.
· Discussion and sufficient preparation and support to decrease negative emotions.
· Problem solving: provide resources (lanyards, literature, information folder)
· Monthly meetings including mentoring to allow reflection on wins; set personal goals and rewards; action planning (also provided by 6 month project plan with action planning)
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Skills-
An ability or proficiency acquired through practice
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Don’t know how to use 37.5% (n=6);
Lack of confidence (and enabler) 25% (n=4); Don’t have time to perform 25% (n=4)
More than 75% never use: skinfold 100%, BIS 90%, handgrip 95%, MUAC 75% (n=20 responders)
75% (n=12) unsure who to use on;
69% (n=11) unsure when to do; 69% (n=11) unsure what to do; 62.5% (n=10) unsure how to interpret;
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Training and awareness in a variety of areas
· Had any training in BCA: 55% (n=22), mostly in arm circumference (75%), skinfolds (75%), BIS (42%) and BIS scale (42%). For DXA, only 8%had any training
· Had any training in BCA: 55% (n=22), mostly in MUAC (75%), skinfolds (75%), BIS (42%) and BIS scale (42%). For DXA, only 8%had any training
· The majority of the team (at least 75%) is aware that skinfold callipers, BIS device, PG-SGA, handgrip, and tape measures are available. A minority is aware of the existence of a BIS scale (n=20)
· Confident to use skinfold (5%), BIS (30%), MUAC 70%, PG-SGA 85%, handgrip 50%, tape measure 75% (n=20)
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Reflective motivation (Cognitive/ interpersonal skills)
Education
Persuasion
Incentivisation
Coercion
Physical capability (physical skills)
Training
Enablement
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Increasing knowledge or understanding
E.g. as above
Using communication to induce positive or negative feelings or stimulate action
E.g. Feedback on the behaviour/ on the outcome(s) of the behaviour,
Focus on past success,
Verbal persuasion about capability,
Persuasive source
Identity associated with changed behaviour
Identification of self as role model,
Information about social and environmental consequences,
Information about health consequences,
Salience of consequences,
Information about others’ approva,l
Social comparison
Creating expectation of reward
E.g.
Feedback on behaviour or
on the outcome(s) of behaviour,
Self-monitoring of behaviour or outcome of behaviour,
Monitoring of (outcome of) behaviour by others without evidence of feedback,
Situation-specify reward,
Reward incompatible behaviour,
Reduce reward frequency,
Reward alternate behaviour,
Remove punishment,
Social reward,
Self-reward,
Behavioural contract,
Commitment,
Discrepancy between current behaviour and goal
Creating expectation of punishment or cost
As above
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As above; incorporate some of the information (in PD or in mentoring) to tap persuasion:
· ’past’ successes (report on project process – either champion or BC team),
· Goal setting and verbal persuasion about capability in mentoring
Incorporated into project plan and engagement and reporting strategy for and with clinical champions (6 month project)
As above, esp. technical skill development
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Social/ professional role and identity-
A coherent set of behaviours and displayed personal qualities of an individual in a social or work setting
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N=6
I think these measures are more appropriate for research 67% (n=4)
I do not think these measurements are appropriate for my area of work 67% (n=4)
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Reflective motivation
Education
Persuasion
Incentivisation
Coercion
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As ‘Skills’
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As above
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Beliefs about capabilities-
Acceptance of the truth, reality, or validity about an ability, talent, or facility that a person can put to constructive use
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37.5% (n=6)
I don't think I could perform these measures accurately
I do not have time to perform these measurements 25% (n=4)
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Reflective motivation
Education
Persuasion
Incentivisation
Coercion
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As ‘Skills’
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As above, especially how to be accurate
As above, especially workflow practices (decide and discuss as a team/s)
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Beliefs about consequences-
Acceptance of the truth, reality, or validity about outcomes of a behaviour in a given situation
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I think these measures are more appropriate for research 67% (n=4)
Don't think these measurements would benefit my practice/tell me anything new/useful 30% (n=3)
I do not expect these measurements to change my practice 11% (n=2)
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N=19 overall Leverage for nasogastric tubes 26% (n=5)
Leverage for pre-surgical provision of enteral/parenteral nutrition 26% (n=5)
Assist in persuading patients to increase intake/supplements 63% (n=12)
Assist in motivation (i.e. to continue on weight loss journey) 79% (n=15)
Ability to more accurately assess energy requirements 89% (n=17)
Ability to provide objective measures/ evaluations of dietetic interventions 84% (n=16)
Assist in identifying malnutrition 58% (n=11)
Would make practice more interesting 74% (n=14)
Would improve my practice 53% (n=10)
With training and time, they (BCAs) could become routine (n=1)
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Reflective motivation
Education
Persuasion
Incentivisation
Coercion
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As ‘Skills’
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As above, especially reflected in the BPIs and WARs – how this may be clinically relevant to measure and monitor; how to make routine; how to monitor; also areas for future research
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Goals-
Mental representation of outcomes or end states that an individual wants to achieve
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62.5% (n=10) unsure how to interpret
75% unsure who to use on
69% unsure when to do
69% unsure what to do
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I would like to learn more about body composition assessment (n=16)
I would like to apply measurement of body composition to my practice (n=15)
Make results more meaningful in practice (n=1)
Applicable in some patient groups (n=1)
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Reflective motivation
Education
Persuasion
Incentivisation
Coercion
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As ‘Skills’
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As above
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Memory, attention and decision processes-
The ability to retain information, focus selectively on aspects of the environment and choose between two or more alternatives
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Not in my daily routine 81% (n=13)
Too much time to do 46% (n=6)
I forget to do 31% (n=4)
Hassle to find reference ranges 54% (n=7)
Difficulties – practicalities (n=1)
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Great that we will have support to routinize (n=1)
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Psychological capability
Education
Training
Enablement
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As ‘Knowledge’
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As above, especially eventually formalise a process of documenting, trialling, evaluation in each WAR; also to consider new staff orientation
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Environmental context and resources-
Any circumstance of a person’s situation or environment that discourages or encourages the development of skills and abilities, independence, social competence, and adaptive behaviour
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N=10 overall
We do not have procedures or forms to report these measurements 70% (n=7)
N=15 overall
I don't have access to the devices I need to perform body composition assessment 27% (n=4)
I don't know where these devices are kept 40% (n=6)
I don't know how to book these devices 80% (n=12)
I know where these devices are kept but I don't know how to get them to the ward 27% (n=4)
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If you can get access to the peapod for routine assessments that would be great 10% (n=1)
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Physical opportunity
Restrictions
Environmental restructuring
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Using rules to reduce the opportunity to engage in the target behaviour (or to increase the target behaviour by reducing the opportunity to engage in competing behaviours)
Changing the physical or social context
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As above
As above, plus purchase of new equipment; process of storing; booking; transporting; cleaning; lanyard ready reckoners
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Social influences-
Those interpersonal processes that can cause an individual to change their thoughts, feelings, or behaviours
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N=13 overall
My peers do not perform these measurements, so why should I? 31% (n=4)
I think they are burdensome to patients 8% (n=1)
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I feel this would add value to Dietitians and patient care in relevant populations
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Social opportunity
Restrictions
Persuasion
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As above
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As above
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Intentions-
A conscious decision to perform a behaviour or a resolve to act in a certain way
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N=18 overall
I never think of doing these measurements when I see or evaluate a patient 39% (n=7)
Not in my daily routine 81% (n=13)
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I would like to know more about what technology we have available and where it would be applicable.
I would certainly consider integrating into practice if and where appropriate.
I would like to add these measurements to my daily routine
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Reflective motivation
Education
Persuasion
Incentivisation
Coercion
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As ‘ Skills’
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As above
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Emotion-
A complex reaction pattern, involving experiential, behavioural, and physiological elements, by which the individual attempts to deal with a personally significant matter or event
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N=14
Don’t want to break device 13/% (n=2)
Feel stressed about the time required 43% (n=6)
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Keen to get started
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Automatic motivation
Persuasion
Incentivisation
Coercion
Environmental restructuring
Modelling
Enablement
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As above
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‘Operationalise and integrate’ into BAU; 6/12 clinical champions project; reported back at teams (EBP & Research Dept meeting) – standing agenda item; future reporting ideas - Audit and feedback (w/ outcomes/positive wins to be shared)
Formalised as “Best BCA adopter” – acknowledged at end of year
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Optimism-
The confidence that things will happen for the best or that desired goals will be attained
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N=19
Unsure if it’ll be burdensome to patients 8% (n=1)
Unsure how perceptive the patients will be 7% (n=1)
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I am ready – bring it on (n=1)
Would improve my practice (n=10)
Will make practice more interesting (n=14)
May increase patients’ motivation to see me to get results (n=1)
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Reflective motivation
Education
Persuasion
Incentivisation
Coercion
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As ‘Skills’
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As above, especially ensure
Monitor and reflect upon benefits (e.g. for next 6 months as extra KPI for reflection – actual measures or ease of measuring outcomes and patient process)
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Reinforcement-
Increasing the probability of a response by arranging a dependent relationship, or contingency, between the response and a given stimulus
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N=18
Nothing that prompts me 22% (n=4)
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More training would prompt me (n=12)
Body comp team makes this possible (n=14)
Integrate into WARs
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Automatic motivation
Persuasion
IncentivisationCoercion
Environmental restructuring
Modelling
Enablement
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As above
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Ensure prompts are incorporated into standard procedures and documents (i.e. WARs) at end of 6/12 BCA clinical champion project
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Behavioural regulation-
Anything aimed at managing or changing objectively observed or measured actions
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N=18
Happy with the way I assess nutritional status 22% (n=4)
Would need to change practice 39% (n=7)
I would need to change my practice regarding assessing nutritional status 56% (n=10)
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Happy to practice if measurements will improve patient care (n=1)
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Psychological capability
Education
Training
Enablement
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As ‘Knowledge’
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BPIs and WARS; especially focussing on Ax of nutritional status
Incorporate into standard processes and procedures – explore and refine with Dept in subsequent PDs and Dept meetings in a planned way
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